I used to live in West Lothian and over the years walked across much of the countryside. Occasionally I would come across a marker stone commemorating events which had taken place in isolated and yet hidden parts of the landscape. Similar markers exist across much of central and lowland Scotland. These are memorials to a turbulent period of Scottish history, the time of the Covenanters.

In the numerous religious disputes of the 17^th century thousands of Scots signed what was known as the National Covenant, in which they pledged to resist changes imposed by King Charles on the Scottish Kirk, and these disputes eventually led to violence and rebellion. After the 1660 Restoration of the monarchy, the Covenanters lost control and dominance, becoming a persecuted minority. During what was known as ‘The Killing Time’ hundreds died in a period from 1679 to 1688. Under severe persecution thousands gathered to worship in their own way out of sight, hidden in conventicles in the Scottish countryside. Attendance was very risky and a serious offence, and preaching at these locations was punishable by death. The memorials bear witness to their determination to resist and to re-shape a new way of being faithful.

All this came to my mind this past week when I read the Feeley Review or to give it its proper title the Independent Review of Adult Social Care in Scotland. The Review was published on Wednesday and has been broadly welcomed. I have read it a few times now and whilst a lot of commentary has been made on its central and core recommendation of creating a National Care Service there are some parts which, I would contend, are equally significant, but which have received less observation. One such is the idea of a social ‘covenant.’

The Report says:

‘One key factor in the realisation of [the aims of the report]… is the need for mutual commitment by citizens, representative bodies, providers, civic Scotland, and national government to set aside self-interest and each work together for the common good. Trust is not currently in plentiful supply in social care support and so we believe that there is a need for an explicit social covenant to which all parties would sign up. This will be particularly important if we want to achieve our aspiration for everyone in Scotland to get the social care support they need to live their lives as they choose and to be active citizens.

In their 2014 report, the World Economic Forum describes a social covenant as a vehicle for giving effect to a common set of values and beliefs:

• The dignity of the human person, whatever their race, gender, background or beliefs;
• The importance of a common good that transcends individual interests; and
• The need for stewardship – a concern not just for ourselves but for posterity.

Together, these offer a powerful, unifying ideal: valued individuals, committed to one another, and respectful of future generations. Fostering these values, which we believe would serve Scotland well as guiding principles for improving social care support, is both a personal and a collective challenge. We must do more than just talk about them; we must bring them into public life and use them to guide decision-making.’

I think the above summarises both the vision and aspiration, the integrity and ethos of this hugely significant landmark report. I personally consider that the time is absolutely right for all of us to rally round the idea of a new national covenant – one of and for social care.

The concept of covenant is an ancient and rich one. Perhaps its oldest use is in religious communities, not least the Judaeo-Christian tradition and scriptures. There it is used as a description of the agreement between God and the ancient Israelites, in which God promised to protect them if they kept his law and were faithful. The everlasting visual sign of this Promise was in the form of a rainbow.

But covenant also carries overtones of law and finance. The word is used today to describe an agreement or promise to provide or do something, or the reverse. It is a legal and defined agreement. In finance and banking it is used as a formal agreement to pay a fixed amount of money regularly especially to a charity.

But in essence both the ancient and modern use of the word carries a depth which goes way beyond the concept of a contract or a formal agreement which can often be based on self-interest. It carries with it a sense of relationship and promise, fulfilment and commitment, solidarity and intent. It is this element I want to focus on in what follows. Much has been written about social covenants and the way they are evident in many societies, but Jonathan Sacks summarises the essence well when he writes:

Social contract creates a state; social covenant creates a society.

The vision painted of a new social covenant in the Feeley Review is one that many of us have been waiting to see articulated for a long time. It is one which puts the autonomy and priority of those who use care and support front and centre. It is one which seeks to embed structures and models, processes and frameworks within a robust human rights perspective. It is one where the direction, the focus, the energy is centred on the citizen. It is one where care and support are not seen as a self-perpetuating means to their own end, but the tool, vehicle and energy by which individuals are able to be part of their own communities and play their full role as citizens.

There will be time elsewhere to go into the detail – because after all that is usually where we find the devil – but for now I think there is an urgency to gather round and to commit collectively to the need not only to reform and change a system which lies in many parts corrupt and broken, but to take the vision, share it, build upon it and implement it.

It has been said that a people without a vision perish. Perhaps we have not literally perished over the past decades in social care, but we have at best stood still, unable to move from principle into practice, from vision into reality. We have allowed aspiration to die and wither away, frozen by the fear of risk and change. The time for day dreaming is well and truly over. The pain of the pandemic has left us with the necessity to heal and bind up, to reform and re-design, there is an urgency to come together and to seek collective agreement and commitment. The three essential characteristics of such a new invigorated social covenant noted above are a good starting point for such a movement.

• The dignity of the human person, whatever their race, gender, background or beliefs.

The Feeley Review calls for a new social covenant where the dignity of the person becomes the cornerstone of all construction. Everything we do, say and implement needs to have the inherent inalienable dignity of a human being at its heart. Within those words is the necessity to change our systems of assessment and allocation, so that we truly listen to the needs and aspirations of those who need support in order to fulfil their lives. It necessitates an end to the iniquity of charging, the lottery of diagnosis, and the formation of equality of resourcing and priority. Dignity is about getting down on our knees to be in the chaos and hurt, the pain and distress that so many find themselves. It means the system and professional, taking off the clothes of authority and power, and re-learning the insights of empathic and affective listening and hearing. It means that we recognise the glorious diversity of individual human beings and not seek to squeeze the individuality of identity, whether race, culture, sexuality or age, into the strait-jacket of pre-planned and determined models and options. Each life grows gloriously unique, a social covenant of social care commits to feeding that growth.

Dignity presupposes a relationship. Dignity is beyond transaction and task rather it sits in the place of mutual learning and respect, it is led by the voice of the person not the sounds of the observer. Dignity is rarely seen in the duality of black and white decisions or statements but settles in the greyness and colourful vibrancy of contradiction and dialogue, of conversation and discovery. A social care system that is truly person-led needs to have flexibility, responsiveness, prevention and dynamic as core principles.

• The importance of a common good that transcends individual interests

Social care at its best is always about connection, not just the maintenance of networks and neighbourhood, but the fostering and creation of new community and new purpose. There is an inescapable public and outward dimension of social care which takes it away from the closed privacy of self-interest. So the Feeley Review is absolutely right, I believe, in asserting the case for fiscal responsibility and transparency in the expenditure of public monies. In a co-operative society true entrepreneurship and economic wellbeing is best served when individual ambition walks alongside collective and societal benefit. The covenants of old were never individual contracts defined solely to benefit self-interest, they were always about a sense of enabling individuals to flourish within a community for the betterment of all. Good effective social care and support does not foster crude individualism but enables the person to achieve their potential in and through being in relationship and community with others. If one voice is not heard then the music is silent; if one person is not present then the community is absent; if one life is not flourishing, then the tree is dying.

• The need for stewardship – a concern not just for ourselves but for posterity.

Stewardship is a concept with a not dissimilar ethical overtone to that of covenant. There is a spiritual and moral imperative to do well by what we have and receive, whether that is through the stewarding of the environment in which we live, or the stewarding of the shared resource we possess to create a better community. The Feeley Review creates a vision not only of a new system and model, but it posits the argument that when we use fiscal and human resources we have to have an intentionality of regard for others in such use. So it is that workforce training and development is so central. So it is that valuing the individual worker and manager by means of fair terms and conditions, by esteem and appropriate status is just as key to stewardship as a commitment to financial probity and transparency. Stewardship within a social covenant is a compulsion to create systems and structures not for the glorification of the moment, or for historical memory but for the inheritance of those who follow us. Short termism rarely creates that which lasts and on which those who follow us can build their own fulfilment.

Do please read the Report, catch a sense of some of its vision and aspiration. It is not all perfect – nothing ever is, but in its suggestion of creating a social covenant I think it is spot on. As people read and reflect, debate and discuss, not least in the next few weeks of political partisanship, I hope we can all find it in ourselves to gather round the need to hold to the vision that this report pulls us towards. I hope that we will have less rhetoric of defence and difference, less soapbox oratory, and more listening and hearing. That is why we need a social covenant for social care.

We cannot do nothing, so we must do something; we cannot sit still, so we must move, we cannot just be silent, so we must finally speak. The vision is there, the covenant is promised. In the glorious words of Miroslav Holub we have to open the door to our future…

The Door

Go and open the door.

Maybe outside there’s

a tree, or a wood,

a garden,

or a magic city.

 

Go and open the door.

Maybe a dog’s rummaging.

Maybe you’ll see a face,

or an eye,

or the picture

of a picture.

 

Go and open the door.

If there’s a fog

it will clear.

 

Go and open the door.

Even if there’s only

the darkness ticking,

even if there’s only

the hollow wind,

even if

nothing

is there,

go and open the door.

 

At least

there’ll be

a draught.

https://www.scottishpoetrylibrary.org.uk/poem/door/

Donald Macaskill

“I am story”.

In a very real and deep sense we are all of us wired into storytelling and story. It feels as if it is part of our DNA, wherever we are and whoever we are in the world we are surrounded by story.

Today marks the start of National Storytelling Week which before the pandemic had taken place in theatres, museums, schools, hospitals, and increasingly in care homes. In a virtual way the coming week will provide folks with a fantastic way to share their own story, or even invent something entirely new. National Storytelling Week is celebrated by all ages and celebrates the power of story to entertain and engage, to inform and include, to conjure mystery and to coracle sadness.

I have written before in these blogs about how I have always loved story and the tellers of tales which have inspired and encouraged me in my life. But at the start of a week where children will paint word pictures of adventure, where some will use words to express emotion and others will simply have fun, it is worth reflecting a bit on why story is important, perhaps especially in these pandemic times.

The best answer to that question, for me at least, comes in the work of Jonathan Gottschall, who in his book, “The Storytelling Animal: How stories make us human” suggests that human beings are natural storytellers—that they can’t help telling stories; that they turn things that aren’t really stories into stories because they like narratives so much. Everything—faith, science, love—needs a story for people to find it plausible. In the world of marketing and elevator pitches, of twitter and text – no story, no sale. Gotschall has said:

“We are, as a species, addicted to story. Even when the body goes to sleep, the mind stays up all night, telling itself stories.”

Stories provide a way of understanding our place in the world by giving structure to what is happening around us. That is the very nature of the big myths of humanity which from the dawning of time sought to explain the unexplainable and to give truth to chaos, safety to fear.

Stories root us in an on-going stream of history – they provide us with a sense of belonging and help establish our identities. Long before the written word there was the spoken word; the oral story constructs the text.

That is why every community, every people, every family has a heritage of stories which have become the truth for them and have helped to foster connection and meaning.

Gottschall argues that just as the brain detects patterns in the visual forms of nature – a face, a figure, a flower – and in sound, – so too it detects patterns in information. Stories are recognisable patterns, and in those patterns we find meaning.

Everyone then has a story.

Life is one long story … it takes us the whole of that life to tell it to its conclusion … Some spend their lives waiting to tell their story… waiting for someone to listen …

It’s not that folks don’t tell tales or share parts of their self but there is a deeper story which is more than just the amalgamation of a set of anecdotes.

It is the story which was told before fire discovered the cave wall, or pen discovered ink, or teenager discovered text … it is the story of who we are, the individual behind the identity we show the world.

This is the story that we want someone to listen to … to really attend to with their whole interest and self … because we may only tell it once, it might only be in fragments, it might only be through the whisper of a silence … but it is the story we NEED to tell.

So if for a moment we accept that story is fundamental to what it means to be human – as many psychologists suggest – what does all this mean for care and in particular what about story and its telling in Covid times?

The week that has passed has tragically seen the reckoning of two statistics – 100,000 people in the UK and 6,000 people in Scotland have died as a result of Covid having tested positive within the last 28 days before their death. Deeply heart-breaking and horrendous.

One of the most tragic aspects of the pandemic is that for thousands upon thousands of individuals their story has been cut short, the next chapter of a life has been left unwritten, they have not had the chance to say goodbye or to finish what they started in their loving and living. But what strikes me as just as sad is that because of the policies of exclusion we have adopted for now eleven months for too many in hospital and care home there has been no-one they have known present to hear their last words, no-one other than a loving stranger to hold their hands in the midst of fear. They have not been able to tell the story of their life and love, of their truth and tear, of their regret and delight.

When I heard these statistics this last week I could not help but think of the hundreds, the thousands, who have died in our care homes, locked away from hands of touch and love, from the presence of family and friend, for these never-ending months of time. I could not help but think of the pain and anguish of family I have spoken to and know and of the anxiety and fear of staff and frontline carers. And we have to remember that during these months we are numbering not just those who have died from Covid for we have had hundreds dying during lockdown. No one wanted or wants this nightmare to be and to continue.

My great inspiration the poet Maya Angelou once said:

“There is no greater agony than bearing an untold story inside you”.

Care is the incarnating of compassion and love so that it enables another person to flourish to their full humanity. Good care allows and frees an individual to tell their story, to be open and honest, vulnerable and authentic. Care is the listener and storyteller in equal measure. Covid has robbed countless thousands of the ability to tell their story, and of the presence of those who loved them to listen to its telling not just at the point of life’s ending but in the days and weeks before. We have been left with a harvest of hurt and harrowing regret which will take years, if ever, to overcome and which has and is traumatising so many today.

As we get vaccinations rolled out, and accurate testing, and PPE and proportionate infection control practices there simply must be a restoration of the presence of family into our care homes. I write that in full acknowledgment of the fear and anxiety, the terror and concern of those staff, managers and operators who have protected folks for so long that they are terrified of the virus infecting and destroying. In the days ahead as Government, providers, staff and families we all need to work together to ensure the restoration of safer visiting into care homes; we need to address the fear not ignore it; we need to remove the anxiety of staff and managers of liability, prosecution and culpability for any act whereby greater access may bring about harm. We need to recognise that life is about risk and relationship as much as it is about safety and protection. We need to work with those family members who are so anxious about visiting loved ones for fear of bringing hurt with them just as much as working with those who are desperate for the touch of love and to simply be with their relatives.

The pandemic has stolen the story of too many, it has corrupted the care we know which brings restoration and put up barriers which have blocked compassion. We have an opportunity to write a new story. We have the chance in coming days to do different and be better. We have within all our communities, by acting one with the other, not in criticism and condemnation, but in solidarity of shared concern, the capacity to write a conclusion worthy of our humanity to what has been a nightmare for too many. We have the power to write a new end.

When the story of this pandemic is finally written will there be space in its pages to tell of the lives of the thousands who are numbered and not named, will there be a space to allow us to grieve for lives unfinished and lost loves?   This pandemic is not just about statistics and science, political action and policy positions. The future should not just be about immunology and vaccines, it has to be about shaping our humanity to the stories of the last eleven months.

Will there be a chapter which shows that when we could we changed and worked hard together to allow people despite the fear of the virus to be together, to better balance protection and presence, to allow people to have folks to listen to the stories of their last months, days and weeks in care home and hospital?

Story is a moment marker and memory holder. We have the power not just in Storytelling Week but in all our hours, months and years to write a story which pulls us forward to a better humanity.We have the power to release the stories untold and to enable a listener to be present.  Let us therefore take up the pen and create it.

Donald Macaskill

The past week has been one of moment and history making. In a sense the Inauguration of any American President is something which tends to stick in the memory – although some of them maybe for the wrong reasons!

So it was that I sat down to watch Joe Biden being inaugurated after weeks of turmoil and anxiety, and amidst all the tradition and formality, I was moved and inspired by the powerful eloquence and rhythmic beauty of the words of the Youth Poet Laureate Amanda Garman. More of that later.

Joe Biden has been around American politics for some time and with age he has gathered a gentle wisdom and insight together with a steely ability to achieve consensus from disharmony. I first began to read a bit of what he had written when he won the election in November and I have been especially impressed by the honesty with which he has come through personal tragedy and the way he speaks about loss and grieving. He has also been someone who has long articulated how important human rights are to him and how they cannot be an add on but must be central to all decision-making, both at a local and international level. In that regard he has written:

‘human rights and fundamental freedoms are each — equally — the entitlement of all. It makes no difference where we live and no matter how we look, how we pray, or whom we love.’

On Thursday last week Scottish Care published a paper which I had written about human rights – it was a continuation of a conversation started a bit more than a year ago when I argued that we should see social care as an inherent part of the human right to health. In this new paper I attempt to do two things. The first was to describe what I believe are some of the key principles that must be present in a human right of social care. The second was to illustrate what that human right of care might look like in practice.

I want to reflect briefly on what that might mean fin these days of the pandemic.

I believe human rights are the foundation which enables us to create a social care sector fit for the future, worthy of the inheritance of hurt we have endured, and a legacy to the hopes, aspirations and dreams of those who work, run and live in our care homes and who work in homecare in our communities.

One of the reasons why human rights speak to me is that they enable us to get closer to articulating a ‘social dimension of social care.’ This is not a play with words but I believe it is important because I feel that in the last eleven months we have seen a creeping clinicalisation or medicalisation of the way in which we support and care for people both in the community and in care homes. That might be partly inevitable in a pandemic, but it must never be our future. We need a recovery of the social dimension of care, a dimension that sees support and care as enabling people to fulfil their potential as citizens, to belong to communities and to enhance their contribution. That is what is social about social care – it is connectedness, community and active participation. It is just as important to finance and resource helping people play a part in their community as it is to repair the fractures of their bones.

Social care is about enabling the fullness of life for every citizen who needs support whether on the grounds of age, disability, infirmity or health. Social care is holistic in that it seeks to support the whole person and in that they it is about attending to the individual’s wellbeing rather than simply their physiological health. It is about removing the barriers that limit and hold back and the fostering of conditions so that individuality can grow, and the independent individual can flourish.

That full citizenship does not happen by accident and for some people it has to be nourished and enabled by social care supports. That is why social care is more than just keeping the clock of life ticking over, it is about filling days with purpose, meaning and value.

Intrinsic to a human right of social care is the ability to enable individuals to be autonomous – this is not a crude individualism, but it is what allows a person to be psychologically, spiritually and physically their fullest self – it is what enables people to flourish into the fullness of who they are as human beings.

If that is true then there is also a truth in that we have stripped out autonomy too often in our response to the pandemic. There is still too little space and place for the voice of those who receive care and support to be heard. There are still too many instances when we do to and advocate for, rather than being attentive to hear the insights, needs and command of those citizens we support in social care and health – even in an emergency pandemic situation. Yes we are in a once in a lifetime emergency – but when do we start to enable people to grow into their individuality rather than restrict them to the conformity of our commands? When do we give control to the individual who receives care and support in care home and own home?

Good care and support are grounded in the realisation that regardless of any cognitive or physical impairments that every human individual has the right to exercise choice, control and autonomy to the best of their abilities and capacity. But that choice has to be rooted in a diversity of options to enable it. A one-size-fits-all model or approach, a take it or leave it offer, does not enable choice, individuality or personal control – it is the State-knows-best attitude which denies authentic autonomous citizenship and corrupts community.

In social care and health care it has become one of the core ethical standards that an individual must be involved in decisions about their own health and wellbeing; must have ultimate control and say in that decision-making and must have an ability to exercise informed choice. So it does indeed matter that I have choice over which care home I want to live in, which worker enters my house to deliver personal care, which service best meets my individual needs.

Choice in social care is not a consumerist added-extra but rather it is the heart of the enabling of the individual to be heard and valued through the way we work to support them. I’m not convinced at all that we have done all that we could have to protect individual choice and personal control during the pandemic.

Now of course, we do indeed use all the right language –  I have read libraries of books about person-centred care over the years – that sense that we put the person and individual at the centre of our compassion and care – all of which no one could disagree with. But a human rights basis of social care is about really empowering individuals and communities. It is about ensuring that the professional is there on tap not on top – ensuring that the primary direction is from the individual. That is always a challenge perhaps especially in environments like a care home where we are living one with the other not as a company of strangers but a community of friends.  What would it take for the system to give real power to the citizen? How can we change to adopting the principle and effect of person-led care and support which empowers an individual to take control and to be autonomous, to exercise real and meaningful choice rather than what happens to be available or what another decides is best for them?

There is a great deal of debate about the future of social care in Scotland and no doubt in the days and weeks to come that will become a loud, partisan and party-political debate. I hope it also becomes one where we all can play our part and have our voices heard. This is everyone’s business – how we develop a social care system fit for the future is far too important to be left to our politicians alone.

The future of social care is I believe, one that has to be grounded on key principles which advance the human right to social care. It might be challenging especially during a pandemic, but these are principles which value the social just as much as the clinical, they enable the autonomy and control of the individual, they offer real meaningful and informed choice, and they foster independence and personal fulfilment in community, care home and own home. I want a social care system in Scotland that is properly resourced, that values the workforce by trusting and rewarding them appropriately, that nourishes skills through education and learning, but which more than anything else is at all times led by the person who uses that care and support, not politicians or policy makers, not worker or provider, not processes or targets, not budgets and finance, but by people whose outcomes truly matter.

I mentioned the inspiring Amanda Gorman who’s poem at the Inauguration stole the show – ‘The Hill We Climb.’  As I listened to it I felt that it could well be a description for the future of social care as a human right in our own nation. This will not be easy, there will be the sweat of energy spent as change is achieved, there will especially in these days of pandemic fear and anxiety, be a sense of being overwhelmed but …

The way we care for those who require to be supported in their citizenship is the truest mark of our identity as a nation – it is nothing short of the fulfilment of society, the enablement of community, the ownership of citizenship – it is about connecting, communicating and celebrating in togetherness.

In the words of Amanda Gorman:

When day comes, we ask ourselves where can we find light in this never-ending shade?
We will rebuild, reconcile, and recover.
In every known nook of our nation, in every corner called our country,
our people, diverse and beautiful, will emerge, battered and beautiful.
When day comes, we step out of the shade, aflame and unafraid.
The new dawn blooms as we free it.
For there is always light,
if only we’re brave enough to see it.
If only we’re brave enough to be it.

(There are many places to see the full text https://www.townandcountrymag.com/society/politics/a35279603/amanda-gorman-inauguration-poem-the-hill-we-climb-transcript/ )

Donald Macaskill